From the Guidelines
The management of a patient with a pericardial cyst typically involves observation for asymptomatic patients, while symptomatic patients may require percutaneous aspiration or surgical resection, as recommended by the 2015 ESC guidelines 1. The approach to managing pericardial cysts depends on the presence of symptoms and the characteristics of the cyst.
- Asymptomatic patients can be monitored with regular follow-up using echocardiography every 6-12 months to assess for changes in cyst size or development of symptoms.
- Symptomatic patients, or those with large or rapidly growing cysts, may require intervention, which can include percutaneous aspiration with or without sclerotherapy, or surgical resection. The diagnostic workup for pericardial cysts includes echocardiography, CT, and eventually CMR to define the size, density, and neighboring structures, as outlined in the 2015 ESC guidelines 1. Key considerations in the management of pericardial cysts include:
- The risk of cardiac compression, rupture, or infection, which can be mitigated with prompt intervention for symptomatic patients.
- The potential benefits of symptom relief and prevention of complications, which must be balanced against the risks of the procedure.
- The importance of a multidisciplinary team approach, including cardiologists and cardiothoracic surgeons, to determine the optimal management strategy for each patient. In cases where the diagnosis is not completely established by imaging or the cyst recurs after drainage, surgical resection may be necessary, as recommended by the 2015 ESC guidelines 1.
From the Research
Management of Pericardial Cysts
The management of pericardial cysts depends on the presence of symptoms and the size of the cyst.
- Asymptomatic patients are typically managed conservatively with regular follow-up imaging 2, 3.
- Symptomatic patients, on the other hand, often require surgical resection of the cyst 2, 4, 5.
- The choice of surgical approach may vary, with options including thoracoscopic excision 2 and median sternotomy 4.
- Minimally invasive interventions or surgery may be necessary in certain instances 4, 3.
Diagnostic Imaging
Diagnostic imaging plays a crucial role in the management of pericardial cysts.
- Magnetic resonance imaging (MRI) is considered the best modality for both diagnosis and follow-up of pericardial cysts 2.
- Computed tomography (CT) and echocardiography are also useful tools for diagnosis and characterization of mediastinal masses 6, 3.
- Serial echocardiogram may be advised for outpatient follow-up in asymptomatic patients 3.
Complications
Pericardial cysts can lead to life-threatening complications, including: